Healthcare Provider Details

I. General information

NPI: 1346738549
Provider Name (Legal Business Name): ADAPT DIVERSION SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2018
Last Update Date: 09/13/2023
Certification Date: 09/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 ADAMS ST
NEW CASTLE KY
40050
US

IV. Provider business mailing address

655 HOLLY HILL DR
COLUMBUS OH
43228-2930
US

V. Phone/Fax

Practice location:
  • Phone: 888-948-6789
  • Fax:
Mailing address:
  • Phone: 740-304-6156
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number252547
License Number StateKY

VIII. Authorized Official

Name: BETHANY T KELLEY
Title or Position: SOLE OWNER
Credential: LCSW
Phone: 740-304-6156